Analysis Of Factors Related To The Safety Of Mother And Child In HBV Infections And Pregnancy

Objective The purpose of this project is to collect the clinical data of patients with HBV infection and pregnancy who are treated in Ningxia Medical University General Hospital,Retrospective analysis of HBV infection combined with pregnancy on maternal and infant safety and related complications and adverse outcomes of the factors,to further prevent or reduce HBV infection pregnant women related complications or adverse outcomes to provide clinical data and data reference.Methods HBs Ag positive pregnant women who were hospitalized and delivered in our hospital from July 2017 to July 2019 were selected as the HBV infection group,the healthy pregnant women who were hospitalized and delivered in our hospital at the same time were selected as the non-infected group by random sampling.The infection group was divided into abnormal liver function and normal group,grouped by HBe Ag positive and negative,grouped by HBV-DNA positive and negative,grouped by antiviral therapy and non-aviral therapy,And compared with the non-infected group,The effects of the above four factors on maternal and infant complications and adverse outcomes(including Postpartum haemorrhage(PPH),Hypertensive Disorders of Pregnancy(HDP),Gestational Diabetes Mellitus(GDM),Prelabor Rupture Of Membranes(PROM),fetal distress,cesarean section,Low Birth Weight Infants(LBWI),neonatal cyanotic asphyxia,premature delivery,stillbirth were analyzed.According to the incidence of maternal and infant complications and adverse outcomes,the infection group was set up as the complication group and no complication group,analysis of the two groups of Album(ALB),Total bilirubin(TBIL),Alanine aminotransferase(ALT),Glutamate aminotransferase(AST)levels.Single factor t test,X~2test or fisher exact probability method,multiple factors using Logistic regression analysis to explore the impact of HBV infection on pregnant patients and related factors affecting their maternal and child safety.Results1.group with abnormal liver function PPH,HDP,PROM,fetal distress,cesarean section,LBWI,neonatal cyanotic asphyxia,premature delivery,stillbirth rate of 22.7%,18.2%,22.7%,1 1.4%,68.2%,13.6%,15.9%,15.9%,1 1.4%,significantly higher than that in the liver function normal group of 5.9%,10.0%,10.6%,3.5%,46.5%,3.5%,5.9%,10.6%,2.9%and non-infection group of 7.0%,4.0%,8.0%,1.0%,45.0%,2.0%,4.0%,P<0.05,there was no significant difference between normal liver function group and non-infection group in PPH,HDP,PROM,fetal distress,cesarean section,LBWI,neonatal cyanotic asphyxia,premature delivery and stillbirth.GDM incidence of the three groups was 14.3%,51.4%,34.3%,the difference was not statistically significant.2.The percentage of cesarean section in the HBe Ag(+)group was 81.0%,which was higher than that in the HBe Ag(-)group,33.3%and the non-infected group,45.%,P<0.05,however,there was no significant difference between HBe Ag(-)group and non-infection group.In HBe Ag(+)group,PPH,HDP,PROM,fetal distress,cesarean section,LBWI,neonatal cyanosis,preterm birth and stillbirth accounted for 3.8%,12.7%,7.6%,12.7%,4.9%,6.3%,8.9%,13.9%,2.5%,the above-mentioned outcomes were 12.6%,11.1%,12.6%,13.3%,4.4%,5.2%,7.4%,10.4%,5.9%in HBe Ag(-)group and 7.0%,4.0%,12.0%,8.0%,1.0%,2.0%,4.0%,4.0%,1.0%in non-infected group,there was no significant difference among the three groups.3.The incidence of premature,PROM,and cesarean section in HBV-DNA(+)group was17.3%,13.5%,63.2%,which was significantly higher than that in HBV-DNA(-)group,6.2%,8.6%,30.9%and 8.0%,4.0%,45.0%,P<0.05%,respectively,however,there was no significant difference in PROM,preterm birth and cesarean section between HBV-DNA(-)group and non-infected group.In HBV-DNA(+)group,PPH,HDP,GDM,fetal distress,LBWI,neonatal cyanosis,fetal death accounted for 8.3%,11.3%,10.5%,3.8%,4.5%,7.5%,3.8%,the above-mentioned outcomes were 11.1%,12.3%,11.1%,6.2%,7.4%,8.6%,6.2%in HBV-DNA(-)group and 7.0%,4.0%,12.0%,1.0%,2.0%,4.0%,1.0%in non-infected group,there was no significant difference among the three groups.4.The incidence PROM,premature delivery in the unaviral treatment group was 16.8%,14.8%,which was significantly higher than that in the antiviral treatment group,4.6%and non-infected group,8.0%,4.0%,P<0.05,respectively,there was no significant difference between antiviral treatment group and non-infection group.In the treatment group,PPH,HDP,GDM,fetal distress,cesarean section,LBWI,neonatal cyanosis and asphyxia,stillbirth accounted for 9.2%,12.3%,10.8%,3.1%,50.8%,7.7%,9.2%and 7.7%,the above-mentioned outcomes were 8.1%,11.4%,10.7%,5.4%,51.0%,5.4%,7.4%,3.4%in the uninfected group and 7.0%,4.0%,12.0%,1.0%,45%,2.0%,4.0%,1.0%in non-infected group,there was no significant difference among the three groups.5.The results showed that abnormal liver function,positive HBV-DNA were risk factors for PROM and premature delivery,with OR 95%CI of 6.369(1.931,21.006),3.593(1.659,7.783),4.447(1.517,13.030),4.116(1.782,9.504)and antiviral therapy as protective factors for PROM and premature delivery,respectively,0.123(0.033,0.452),0.015(0.002,0.126).Abnormal liver function is a risk factor for cesarean section,and its OR 95%CI is 7.139(3.133,16.265),there was no significant relationship between HBe Ag and HBV-DNA positive and cesarean section rate.6.Statistical analysis showed that,The number of patients with these complications in the infected group was 99,46.3 percent,The number of patients without these complications was 115,53.7 percent.The albumin in the complication group was(32.77±4.82)g/L,lower than that in the non complication group(36.57±5.11)g/L,P<0.05.The ALT of complication group was(58.94±36.02)U/L,higher than that of complication group ALT(32.73±20.52)U/L,P<0.05.The AST of complication group was(51.16±38.05)U/L,higher than that of complication group AST(29.70±18.86)U/L,P<0.05.The total bilirubin in the complication group was(14.31±12.55)umol/L,and the total bilirubin in the non complication group was(11.58±6.13)umol/L,the difference was not statistically significant.Conclusion1.Abnormal liver function and HBV-DNA positive in pregnant patients with HBV infection will increase maternal and infant complications and adverse outcomes,while anti-virus treatment can reduce the occurrence of related maternal and infant complications or adverse outcomes,therefore,the liver function and HBV-DNA should be monitored during pregnancy,and the symptomatic treatment should be done actively.2.Patients with HBV infection complicated with pregnancy should be treated according to indications to reduce the level of HBV-DNA and reduce the incidence of complications and adverse outcomes.